Ob-Gyn Coding Alert

Question: How should I code for a total vaginal hysterectomy with bilateral salpingo-oophorectomy, anterior and posterior colporrhaphy, enterocele repair, and laparoscopic Burch bladder neck suspension? Florida Subscriber Answer: Based on your description, the Burch appears to be the only procedure performed through the laparoscope. In that case, you are dealing with laparo-scopic and vaginal procedures, and your options are as follows: 58263 Vaginal hysterectomy; with removal of tube(s), and/or ovary(s), with repair of enterocele (25.83 RVUs) 51990-51 Laparoscopy, surgical; urethral suspension for stress incontinence, multiple procedures (22.13 RVUs) 57260-51 Combined anteroposterior colpor-rhaphy, multiple procedures (14.27 RVUs). Alternatively, you may code the scenario as follows: 58262 Vaginal hysterectomy; with removal of tube(s), and/or ovary(s) (23.85 RVUs) 51990-51 (22.13 RVUs) 57265-51 Combined anteroposterior colpor-rhaphy; with enterocele repair, multiple procedures (19.70 RVUs). Because many payers like to bundle the anterior and posterior repair into the total hysterectomy, the second option is most likely the best for optimal reimbursement. Bare in mind that enterocele repair will be paid only if the condition was present. If the repair was done to prevent future enterocele, the payer will deny it.